Conocimiento nosográfico y actitud de los internos de medicina del Hospital Nacional Arzobispo Loayza frente a pacientes con tuberculosis, diciembre 2013

Publicación a texto completo no autorizada por el autorDetermina la relación que existe entre el conocimiento nosográfico y la actitud de los internos de medicina del Hospital Nacional Arzobispo Loayza (HNAL) frente a pacientes diagnosticados con tuberculosis (TB). Se aplican encuestas sobre conocimientos y actitudes de los internos de medicina del HNAL frente a pacientes diagnosticados con TB. El conocimiento se considera en tres apartados (general, vías de contagio y síntomas), que integrados muestran el conocimiento global. Respecto a la parte actitudinal se considera dos vertientes: la conducta ante una persona que padeció o padece de TB y la conducta a partir de la posibilidad de que la persona o un familiar contraiga o le sea diagnosticada la enfermedad; y a la integración de ambas como la actitud general. Se busca la relación entre conocimientos y actitudes mediante la prueba estadística de Chi Cuadrado, con un nivel de significancia de 0.05. Se encuestan a 86 internos de medicina. En conocimientos obtienen una evaluación adecuada, 38 (44.19%) en conocimiento general, 77 (89.53%) en sintomatología y 74 (86.05%) sobre vías de contagio y 58 (67.4%) de conocimiento global. Sobre la actitud ante una persona que padeció o padece de TB, 50 (58.14%) presentan actitud positiva, 24 (27.91%) indiferente, 12 (13.95%) negativa; y respecto a la conducta a partir de la posibilidad de que la persona o un familiar contraiga o le sea diagnosticada TB, 64 (74.42%) positiva, 16 (18.60%) indiferente, 6 (6.98%) negativa. La actitud en general es 52 (60.47%) positiva, 23 (26.74%) indiferente, 11 (12.79%) negativa. No se encuentra relación entre los conocimientos y las actitudes frente a los pacientes con TB. Concluye que el nivel de conocimientos adecuado es el que predomina con 67.4%, siendo los posibles síntomas el área con mayor acierto. La actitud ante una persona que padece de TB, la actitud frente la posibilidad de adquirir la enfermedad uno mismo o un familiar y la actitud en general es positiva en más del 50%. El nivel de conocimientos no influye significativamente en las actitudes de los internos de medicina frente a los pacientes con TB.Tesi

Congenital adrenal hyperplasia causing male infertility. Report of one case Alteración de la fertilidad masculine por hiperplasia suprarrenal congénita. Azoospermia reversible con terapia de glucocorticoide

In males, congenital adrenal hyperplasia due to 21 hydroxylase defi ciency is associated to normal fertility or infertility caused by a hypogonadotrophic hypogo-nadism (HH) or gonadal damage caused by intratesticular adrenal remnants. We report a 29-year-old male with azoospermia, without any important personal or family background. Physical examination was normal, his height was 150 cm and his testicular volume was 10 ml (normal 15 to 25 ml). Laboratory showed a normal testosterone and FSH and LH in the low normal limit. These results discarded a HH, whose diagnostic requirements are a low testosterone and inadequately normal or low gonadotrophins. A testicular biopsy was informed as compatible with HH. A 21 hydroxylase defi ciency was suspected and confi rmed with extremely high levels of 17 hydroxyprogesterone at baseline and after stimulation with fast acting ACTH. Clomiphene citrate did not increase testosterone or gonatrophin levels. Testicular ultrasound discarded the presence

Association of age with sperm DNA fragmentation Aumento del daño en el ADN espermático en varones mayores de 40 años

Background: There is an association between aging and an increased number of sperms with alterations in nuclear DNA. Aim: To study the association between age and fragmentation of sperm DNA. Material and Methods: Sixty two volunteers provided semen for analysis. These were separated in a group aged less than forty years and a second group aged more than forty years. Sperm DNA fragmentation was studied by TUNEL (terminal deoxynucleotidyl transferase-mediated 2'-deoxyuridine 5'-triphosphate nick end-labeling) and SCD (sperm chromatin dispersion test) assays. Results: Compared with their younger counterparts, patients aged more than 40 years had a higher proportion of sperms with DNA fragmentation by TUNEL (20 ± 1.3 and 24 ± 1.9% respectively, p < 0.05) and SCD (22 ± 1.4 and 26 ± 1.6% respectively, p < 0.05). The results of both assays had a correlation coefficient of 0.8. No differences between groups were observed for other seminal parameters. Conclusions: Sperm DNA fragmentation incre

Influence of size and duration of gynecomastia on its response to treatment with tamoxifen Terapia médica de la ginecomastia con tamoxifeno. Influencia del volumen y duración de la ginecomastia en el resultado terapéutico

Background: Gynecomastia is treated when it is painful, there are psychosocial repercussions or it does not revert in less tan two years. It is treated with the antiestrogenic drug tamoxifen, but there are doubts about its effectiveness in high volume gynecomastias or in those lasting more than two years. Aim: To assess the effectiveness and safety of tamoxifen for gynecomastia and the influence of its volume and duration on the response to treatment. Patients and methods: Forty three patients with gynecomastia, aged 12 to 62 years, were studied. Twenty seven patients had a pubertal physiological gynecomastia, in eight it was caused by medications, in four it was secondary to hypogonadism, in three it was idiopathic and in one it was due to toxic exposure. Twenty patients had mastodynia and in 33, gynecomastia had a diameter over 4 cm. It lasted less than two years in 30 patients, more than two years in nine and four did not recall its duration. All were treated with tamoxifen 20 mg/d

Etiological study of gynecomastia. Results of a prospective study and recommendations Etiología de la ginecomastía. Importancia de no subdiagnosticar una ginecomastia patológica

Background : Gynecomastia can be physiological or pathological. A limited study of gynecomastia is recommended during puberty and in the elderly, ages in which gynecomastia is usually considered physiological. Other authors suggest that this condition should be studied when it is painful, rapidly growing, of recent onset, when its diameter is more than 4 cm and when is associated to testicular masses. Aim: To investigate the causes of gynecomastia and to evaluate the above mentioned criteria to exclude pathological conditions. Material and methods: Prospective study of 117 patients aged 10 to 83 years, consulting for gynecomastia. All were subjected to a standardized study including a clinical examination and measurement of plasma estradiol and testosterone levels. Results: Forty one percent of gynecomastias were considered pathological and the rest, physiological. Among pathological conditions, 18 patients had an endocrine etiology (hypogonadism in ten patients, estrogen secreting tu